Individual
STACY ELLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
323 CHURCH AVE NE, JACKSONVILLE, AL 36265-1868
(256) 365-2374
Mailing address
323 CHURCH AVE NE, JACKSONVILLE, AL 36265-1868
(256) 365-2374
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2037893
AL
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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